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Medical Authorization Withdrawal In Suffolk

Category:
Releases and Waivers - Medical
State:
Multi-State
County:
Suffolk
Control #:
US-00426
Format:
Word; 
Rich Text
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Description

Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled.
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Medical Authorization Withdrawal In Suffolk
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